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HB2343 Engrossed |
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LRB094 05025 BDD 39283 b |
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| AN ACT concerning State government.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| Section 5. The Illinois Health Finance Reform Act is |
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| amended by changing Section 4-2 as follows:
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| (20 ILCS 2215/4-2) (from Ch. 111 1/2, par. 6504-2)
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| Sec. 4-2. Powers and duties.
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| (a) (Blank).
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| (b) (Blank).
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| (c) (Blank).
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| (d) Uniform Provider Utilization and Charge Information.
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| (1) The Department of Public Health shall require that |
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| all hospitals and ambulatory surgical treatment centers
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| licensed to operate in the State of Illinois adopt a |
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| uniform system for
submitting patient claims and encounter |
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| data
charges
for payment from public and private payors. |
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| This system shall be based upon adoption of the uniform
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| electronic hospital billing form pursuant to the Health |
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| Insurance
Portability and Accountability Act.
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| (2) (Blank).
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| (3) The Department of Insurance shall require all |
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| third-party payors,
including but not limited to, licensed |
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| insurers, medical and hospital service
corporations, |
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| health maintenance organizations, and self-funded employee
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| health plans, to accept the uniform billing form, without |
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| attachment as
submitted by hospitals pursuant to paragraph |
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| (1) of subsection (d) above,
effective January 1, 1985; |
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| provided, however, nothing shall prevent all
such third |
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| party payors from requesting additional information |
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| necessary to
determine eligibility for benefits or |
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| liability for reimbursement for
services provided.
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| (4) By no later than 60 days after the end of each |
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HB2343 Engrossed |
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LRB094 05025 BDD 39283 b |
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| calendar quarter, each
Each hospital
licensed in the State |
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| shall electronically submit to
the Department inpatient |
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| and outpatient claims and encounter
patient
billing data |
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| related to surgical and invasive procedures collected |
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| under paragraph (5) for each patient. |
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| By no later than 60 days after the end of each calendar |
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| quarter, each ambulatory surgical treatment center |
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| licensed in the State shall electronically submit to the |
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| Department outpatient claims and encounter data collected |
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| under paragraph (5) for each patient.
conditions and |
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| procedures required
for public disclosure pursuant to |
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| paragraph (6).
For hospitals, the billing
data to be
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| reported shall include all inpatient surgical
cases.
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| Billing data submitted under this Act
shall not include a |
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| patient's name,
address,
or
Social Security number.
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| (5) By no later than January 1, 2006
January 1, 2005 , |
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| the Department must collect and
compile
claims and |
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| encounter
billing data related to surgical and invasive |
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| procedures
required under paragraph (6) according to |
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| uniform electronic
submission formats as required under |
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| the Health Insurance Portability and
Accountability Act. |
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| By no later than January 1, 2006, the Department must |
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| collect and compile from ambulatory surgical treatment |
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| centers the claims and encounter data according to uniform |
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| electronic data element formats as required under the |
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| Health Insurance Portability and Accountability Act of |
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| 1996 (HIPAA).
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| (6) The Department shall make available on its website |
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| the
"Consumer Guide to Health Care" by January 1, 2006. The |
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| "Consumer
Guide to Health Care" shall include information |
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| on at least 30 inpatient conditions and
procedures |
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| identified by the Department that demonstrate the highest
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| degree of variation in patient charges and quality of care . |
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| By no later than January 1, 2007, the "Consumer Guide to |
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| Health Care" shall include information for both inpatient |
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| and outpatient conditions and procedures . As to each
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LRB094 05025 BDD 39283 b |
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| condition or procedure, the "Consumer Guide to Health Care" |
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| shall include
up-to-date comparison information relating |
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| to volume of cases, average
charges, risk-adjusted |
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| mortality rates, and nosocomial infection rates.
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| Information disclosed pursuant to this paragraph on
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| mortality and infection rates shall be based upon |
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| information hospitals
and ambulatory surgical treatment |
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| centers have either (i)
previously submitted to the |
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| Department pursuant to their obligations
to report health |
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| care information under this Act or other public health |
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| reporting laws
and regulations outside of this Act or (ii) |
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| submitted to the Department under the provisions of the |
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| Hospital Report Card Act .
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| (7) Publicly disclosed information must be provided in |
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| language
that is easy to understand and accessible to |
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| consumers using an
interactive query system.
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| (8) None of the information the Department discloses to |
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| the public
under this subsection may be made available |
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| unless the information has
been reviewed, adjusted, and |
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| validated according to the following process:
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| (i) Hospitals , ambulatory surgical treatment |
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| centers,
and organizations
representing hospitals , |
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| ambulatory surgical treatment centers, purchasers, |
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| consumer groups, and health plans are
meaningfully |
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| involved in the development of all aspects of
the |
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| Department's methodology for collecting, analyzing, |
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| and
disclosing the information collected under this |
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| Act, including
collection methods, formatting, and |
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| methods and means for
release and dissemination;
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| (ii) The entire methodology for collecting
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| collection and
analyzing the data is disclosed to all |
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| relevant organizations
and to all providers that are |
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| the subject of any information to
be made available to |
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| the public before any public disclosure
of such |
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| information;
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| (iii) Data collection and analytical methodologies |
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LRB094 05025 BDD 39283 b |
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| are
used that meet accepted standards of validity and |
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| reliability
before any information is made available |
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| to the public;
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| (iv) The limitations of the data sources and |
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| analytic
methodologies used to develop comparative |
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| provider
information are clearly identified and |
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| acknowledged,
including, but not limited to, |
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| appropriate and inappropriate
uses of the data;
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| (v) To the greatest extent possible, comparative
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| hospital and ambulatory surgical treatment center
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| information initiatives use standard-based
norms |
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| derived from widely accepted provider-developed
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| practice guidelines;
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| (v-5) For ambulatory services, information is |
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| provided on surgical infections and mortality for |
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| selected procedures, as determined by the Department, |
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| based on review by the Department of its own, local, or |
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| national studies.
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| (vi) Comparative hospital and ambulatory surgical |
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| treatment center information and other
information |
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| that the Department has compiled regarding
hospitals |
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| and ambulatory surgical treatment centers is shared |
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| with the hospitals and ambulatory surgical treatment |
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| centers under review prior to
public dissemination of |
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| the information and these providers
have an |
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| opportunity to make corrections and additions of
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| helpful explanatory comments about the information |
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| before
the publication;
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| (vii) Comparisons among hospitals and ambulatory |
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| surgical treatment centers adjust for
patient case mix |
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| and other relevant risk factors and control
for |
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| provider peer groups , if applicable ;
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| (viii) Effective safeguards to protect against the
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| unauthorized use or disclosure of hospital and |
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| ambulatory surgical treatment center information are
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| developed and implemented;
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LRB094 05025 BDD 39283 b |
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| (ix) Effective safeguards to protect against the
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| dissemination of inconsistent, incomplete, invalid,
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| inaccurate, or subjective provider data are developed |
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| and
implemented;
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| (x) The quality and accuracy of hospital and |
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| ambulatory surgical treatment center information
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| reported under this Act and its data collection, |
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| analysis, and
dissemination methodologies are |
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| evaluated regularly; and
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| (xi) Only the most basic identifying information |
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| from
mandatory reports is used, and patient |
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| identifiable
information is not released. The input |
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| data collected
by the Department shall not be a public |
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| record under the
Illinois Freedom of Information Act.
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| None of the information
the Department discloses to the |
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| public under this Act may be
used to establish a standard |
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| of care in a private civil action.
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| (9) The Department must develop and implement an |
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| outreach
campaign to educate the public regarding the |
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| availability of the "Consumer
Guide to Health Care".
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| (10) By January 1, 2006,
Within 12 months after the |
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| effective date of this amendatory
Act of the 93rd General |
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| Assembly, the Department must study the
most effective |
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| methods for public disclosure of patient claims and |
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| encounter
charge data and
health care quality information |
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| that will be useful to consumers in making
health care |
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| decisions and report its recommendations to the
Governor |
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| and to the General Assembly.
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| (11) The Department must undertake all steps necessary |
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| under
State and Federal law , including the |
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| Gramm-Leach-Bliley Act and the HIPAA privacy regulations, |
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| to protect patient confidentiality in order to prevent
the |
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| identification of individual patient records.
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| (12) The Department must adopt rules for inpatient and |
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| outpatient data collection and report this no later than |
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| January 1, 2006. |
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HB2343 Engrossed |
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LRB094 05025 BDD 39283 b |
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| (13) In addition to the data products indicated above, |
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| the Department shall respond to requests by government |
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| agencies, academic research organizations, and private |
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| sector organizations for purposes of clinical performance |
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| measurements and analyses of data collected pursuant to |
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| this Section. |
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| (14) The Department must evaluate additional methods |
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| for comparing the performance of hospitals and ambulatory |
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| surgical treatment centers, including the value of |
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| disclosing additional measures that are adopted by the |
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| National Quality Forum, The Joint Commission on |
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| Accreditation of Healthcare Organizations, the Centers for |
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| Medicare and Medicaid Services, or a similar national |
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| entity that establishes standards to measure the |
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| performance of health care providers. The Department shall |
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| report its findings and recommendations on its Internet |
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| website and to the Governor and General Assembly no later |
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| than January 1, 2006.
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| (e) (Blank).
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| (Source: P.A. 92-597, eff. 7-1-02; 93-144, eff. 7-10-03.)
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| Section 99. Effective date. This Act takes effect upon |
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| becoming law.
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